Medicaid Settlement with DHH

Posted on November 12, 2014 by BSW

But Why? The right to know why Medicaid denied your claim

A recently filed lawsuit, Wells v. Kliebert, Secretary of the Louisiana DHH, 3:14-cv-00155, will be changing the face of Medicaid denial notices. Wells was filed against the Louisiana Department of Health and Human services alleging that the DHH systematically failed to give adequate notice and explanations of why Medicaid claims were denied. The suit alleged the lack of reasoning for the denials was a violation of the Due Process Clause of the U.S. Constitution. After the suit was preliminary certified as a class action, DHH and the class discussed a settlement for the matter. On October 24, 2014, The Middle District of Louisiana entered an order certifying the class in the suit and partially dismissing the suit, conditioned on the parties’ compliance with their agreed upon settlement. Continue reading →

The Skinny on Implementing Presumptive Eligibility

Posted on November 3, 2014 by BSW

Previously, we discussed Presumptive Eligibility. Here’s the Skinny on becoming a Hospital Presumptive Eligibility Qualified Entity (“HPEQE”) and implementing Presumptive Eligibility in your facility: Continue reading →

Presumptive Eligibility has Arrived in Louisiana

Posted on October 29, 2014 by BSW

Effective January 1, 2014, Louisiana implemented a Presumptive Eligibility program, which allows qualified hospitals to be designated as entities qualified to make presumptive Medicaid eligibility determinations based on primary, self-attested information obtained from individuals seeking medical assistance. Once a hospital determines the presumptive eligibility of a patient, the hospital is guaranteed payment for services that are covered by the state Medicaid plan during a temporary period. If the patient turns out not to be eligible for Medicaid, there is no recoupment of the payments. The program is monitored and executed by the Louisiana Department of Health and Hospitals (“DHH”), which is the designated State Medicaid agency.

Written by: Danielle L. Borel

Technology Shaping Healthcare: Telepharmacies

Posted on October 27, 2014 by BSW

A new structure of pharmacies has begun to spread across the United States. The Model State Pharmacy Act written by the National Association of Boards of Pharmacy describes telepharmacies as providing “Pharmacist Care by registered Pharmacies and Pharmacists located within US jurisdictions through the use of telecommunications or other technologies to patients or their agents at distances that are located within US jurisdictions”. These small kiosk-like pharmacies are usually based in rural areas that could not otherwise sustain a fully operating pharmacy. Often, the most expensive part of a traditional pharmacy is employing the pharmacist. In contrast, telepharmacies are staffed by pharmacy technicians who communicate electronically with a pharmacist at another main pharmacy location. While pharmacy technicians do not have the training to discuss patient care—such as dosage and alternative medicines—with the patients, patients can consult with the remote pharmacist through electronic video conferencing. Both the business model and technology of telepharmacies offer a wide range of opportunities for healthcare providers.

Telepharmacies began in North Dakota in 2001 after North Dakota faced an increasing problem of closing pharmacies. Since then, over 20 states have implemented procedures allowing telepharmacies. States that allow telepharmacies have legislated on aspects such as geographical restrictions, pharmacist-to-technicians ratios, and security of the patient’s health information. Currently, Louisiana has not approved the use of telepharmacies.

Written by: Danielle L. Borel

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Medical Records Questionnaires Overstepping Boundaries

Posted on October 24, 2014 by BSW

Frequently, requests for medical documents are accompanied by a set of questions to be filled out by the custodian turning over the records. The questions are designed to help the party receiving the documents establish that the records are “business records” under the rules of evidence. Surprisingly, many of these requests for information are improper. If a questionnaire accompanies a federal subpoena duces tecum, there is no obligation for a non-party to answer the questions. According to the Federal Rules of Civil Procedure, testimony from a non-witness—which includes a custodian of medical record—can only be garnered by three mechanisms: 1) consent of the non-party, 2) a subpoena for a deposition pursuant to Rule 45, or 3)a subpoena for a deposition by written questions pursuant to Rule 31.

Written by: Danielle L. Borel